ELECTIVES AND SELECTIVES DURING RESIDENCY

The range and abundance of elective and ambulatory selective time during neurology residency allows residents to explore many areas of neurology in greater depth. The total elective and selective time is 8 months spread over the 3 years of training, with 4.5 months occurring during the PGY-4 year. During the ambulatory selective time, residents choose between several ambulatory selective options (neuromuscular, epilepsy, movement, multiple sclerosis, stroke and general neurology). Elective time is also commonly used for clinical activities, but may also be used for research projects (basic science or clinical) or writing projects (e.g. case reports, literature reviews for publication).

Examples of clinical electives:

Headache: the headache center at Columbia has two offices where residents will see patients with Drs. Chou, Cesar and Fryer. Emphasis will be on management and treatment of complicated headache syndromes, as well as exposure to the use of Botox for the treatment of migraine. This elective is complemented by the resident headache clinic.

Interventional neuroradiology or interventional vascular neurology: three active interventional faculty are available with training in neurology, radiology and neurosurgery. Residents on this rotation care for patients before and after procedures and assist in the angiography suite during cases. This rotation takes advantage of the broad range of diseases at CUMC, including acute ischemic stroke, subarachoid hemorrhage and vaso-spasm, AVM's, carotid stenosis, and tumor embolization.

Neuromuscular/EMG Rotation allows PGY-3 and PGY-4 residents to interact and learn from our clinical neurophysiology fellows and faculty. Clinical testing sessions are supplemented with didactic lectures and patient care rounds, including one session of nerve and muscle histopathology, daily case review, weekly EMG didactic lectures, weekly combined clinical neurophysiology lectures, the weekly Muscle Rounds Conference, MDA Clinic participation, and impromptu lectures based on clinical studies. The residents are required to do the EMG elective at some point of their choosing during residency.

Aging and Dementia: this outpatient elective allows for a broad exposure of all aspects of neuro-behavioral disturbances by seeing patients with faculty with a broad range of interests. Residents care for patients with Alzheimer's disease, Fronto-temporal dementia, Lewy body disease, vascular dementia, and Huntington's disease. Residents will also participate in inpatient consults with the service which includes typically an evaluation of rapidly progressive dementias such as paraneoplastic and prion diseases. Residents on this rotation also have the unique opportunity to attend the multidisciplinary Huntington's Disease Clinic, run by Dr. Karen Marder. Interested residents can also observe neuropsychological testing, and accompany faculty on home visits.

Neuroradiology: a popular rotation at CUMC, particularly for PGY-2 residents, where neurology residents assist in the reading of neuro-radiological films including CT, myelography, MRI, and PET under the supervision of a diverse group of faculty. While on this rotation, residents can often observe LPs and myelograms done under fluoroscopy.

Movement disorders: residents may take advantage of the world class movement disorders faculty at CUMC to see a broad range of diseases. Residents will evaluate and participate in treatment of patients with Parkinson's disease at all stages, as well as other adult and child movement disorders. This elective is complemented by Tuesday morning video rounds and CPC with Dr. Stanley Fahn, Botox clinic, and Huntington's disease clinic.

Continuous EEG: this elective allows those residents with an interest in EEG/epilepsy to spend dedicated time reading continuous EEGs with the epilepsy fellow on the cEEG rotation. This includes the monitoring of critically ill patients that are being followed both on other services (with neurology consulting) as well as in our own NICU. Other opportunities while on this rotation include attending the various other epilepsy conferences, as well as reading routine EEGs if desired.

General neurology/Ambulatory neurology: residents may hone their ambulatory neurology skills via a rotation with the Columbia Neurology group seeing patients in a supervised setting. Educational activities are broadened by also seeing patients in the dementia, multiple sclerosis, neuro-otology, and neuro-oncology practices.

The neuropathology rotation introduces residents to the Department of Pathology and Cell Biology's remarkable Division of Neuropathology. Here, residents are exposed to a broad range of pathology, both grossly and under the microscope, and attend brain cutting sessions each Friday morning. Working alongside the neuropathology faculty and fellows, residents are able to gain a deeper understanding of both neuroanatomy and neuropathology, often going to the OR to look at frozen sections.

Neuro-ophthalmology: the Department of Ophthalmology has 3 neuro-ophthalmologists on staff with an active clinical practice seeing a variety of diseases. Residents on this elective evaluate patients in the faculty practice and present to the supervising faculty, and have an additional chance to attend weekly neuro-ophthalmology clinic along with ophthalmology residents to gain a broader understanding of diseases in the orbit and central nervous system.

Multiple sclerosis and neuroimmunology: residents have the option to broaden their education in neuro-immunology that starts with ambulatory neurology at CUMC, and is highlighted with attending MS clinics at the Cornell campus. This rotation may be performed under the supervision of Dr. Claire Riley seeing patients in the faculty practice and clinic, though residents have also performed this elective at away sites including Mount Sinai and Cornell.

Neuroethics: this important educational opportunity is approached through a combination of lectures, small group case presentation and discussion sessions facilitated by center for bioethics (CFB) faculty, interdepartmental conferences, and a syllabus of essential and reference readings for self-directed learning. In addition residents are actively involved in performing and presenting ethics consultations.

International electives: formal away electives are available for residents in traveling overseas during their clinic-free elective of one month duration. Residents may rotate with university affiliates in Durban, South Africa as well as to the Dominican Republic. A formal elective to Puerto Rico is currently being planned.

Amy C. Jongeling, MD, PhD, presenting on her international elective in South Africa

In addition to the electives offered here at Columbia, residents are welcome to do away electives at other neurology departments in New York and beyond.